Ross Robert, Lam Miu, Blair Steven N, Church Timothy S, Godwin Marshall, Hotz Stephen B, Johnson Ana, Katzmarzyk Peter T, Lévesque Lucie, MacDonald Susan
School of Kinesiology and Health Studies, 28 Division St, Queen's University, Kingston, ON K7L 3N6, Canada.
Arch Intern Med. 2012 Mar 12;172(5):414-24. doi: 10.1001/archinternmed.2011.1972. Epub 2012 Feb 27.
The efficacy of physical activity with a healthful diet to reduce obesity is established; however, little is known about the translation of effective lifestyle strategies for obesity reduction in primary care settings.
We assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practices to reduce obesity. A total of 490 sedentary, obese adults were randomized to usual care (n = 241) or to the behavioral intervention (n = 249). The usual care group received advice from their physicians about lifestyle as a strategy for obesity reduction. The behavioral intervention included individual counseling from health educators to promote physical activity with a healthful diet. The primary outcome was change in waist circumference (WC).
A total of 396 participants completed the trial (80.8%). A significant main effect was observed for WC change within the intervention compared with usual care (P < .001) that was sustained at 24 months (mean [SE], -0.9 [0.4] vs 0.2 [0.4] cm; P = .05). Secondary analyses revealed significant main effects for change in WC in men (P = .009) and women (P = .02). In men, the mean (SE) reduction in WC at 24 months was greater with behavioral intervention compared with usual care (-1.6 [0.6] vs 0.1 [0.6] cm; P = .049). In women, the behavioral intervention was associated with differences in WC compared with usual care at 6 and 12 months (P ≤ .01) but not at 24 months (P = .10).
Behavioral intervention in clinical settings is associated with modest reductions in WC during a 2-year study in obese patients. However, the effectiveness of the intervention is restricted to men.
clinicaltrials.gov Identifier: NCT00665158.
体育活动与健康饮食相结合对减轻肥胖的功效已得到证实；然而，在初级保健机构中，关于将有效的生活方式策略转化为减轻肥胖的方法，人们所知甚少。
我们评估了一项完全在临床实践中实施的、为期两年的基于行为的体育活动和饮食计划对减轻肥胖的有效性。共有490名久坐不动的肥胖成年人被随机分为常规护理组（n = 241）或行为干预组（n = 249）。常规护理组从医生那里获得关于生活方式的建议，作为减轻肥胖的策略。行为干预包括健康教育工作者的个别咨询，以促进体育活动和健康饮食。主要结局是腰围（WC）的变化。
共有396名参与者完成了试验（80.8%）。与常规护理相比，干预组的腰围变化有显著的主效应（P <.001），且在24个月时仍持续存在（均值[标准误]，-0.9 [0.4] 对0.2 [0.4] cm；P =.05）。二次分析显示，男性（P =.009）和女性（P =.02）的腰围变化有显著的主效应。在男性中，与常规护理相比，行为干预在24个月时腰围的平均（标准误）减少幅度更大（-1.6 [0.6] 对0.1 [0.6] cm；P =.049）。在女性中，行为干预在6个月和12个月时与常规护理相比，腰围存在差异（P ≤.01），但在24个月时无差异（P =.10）。
在一项针对肥胖患者的两年研究中，临床环境中的行为干预与腰围适度减少有关。然而，干预的有效性仅限于男性。
clinicaltrials.gov标识符：NCT00665158。
